Episode 04: In conversation with Sherry Janzen
Sherry started questioning the way things were done in Long Term Care from the time she took her first job as an Activities Director. Her quest for finding a better way to provide care that is in tune with residents continues to this day.
Today, your host Ellen Gardner, Communications and Marketing at HIROC, speaks with Sherry Janzen, CEO of Salem Home in Winkler, Manitoba.
Salem Home sits in a rural part of Manitoba but their innovative Relationship-Centred Model of Care has attracted international attention. Sherry discovered her affinity for older people early in her career and at the urging of her father, studied gerontology at Wichita State University. A defining characteristic of Sherry’s leadership at Salem Home, where she has been CEO since 2004, is coaxing staff to ask why things are done a certain way and to give new approaches a chance. A key priority for Sherry and her leadership team is ensuring staff receive specialized training in managing the home’s high numbers of residents living with dementia and Alzheimer’s. It’s been ten years since Salem implemented the Relationship-Centred Model of Care and as it continues to evolve, Sherry is proud of the fact at this point they don’t just talk about the culture, they live it.
Ellen Gardner: Good afternoon. I'm Ellen Gardner. I work in marketing and communications at HIROC, and today we have the good fortune of talking to Sherry Janzen, who is the CEO of Salem Home in Winkler, Manitoba. Welcome, Sherry.
Sherry Janzen: Thank you. It's good to be here.
Ellen Gardner: Sherry, maybe we can start the conversation by you telling me how you got your start in healthcare.
Sherry Janzen: Interestingly enough, I started out as a healthcare attendant in one of our local nursing homes in Saskatchewan, and was there for 10 years and found I had a natural affinity with older people, loved working with them, loved doing different things with them. I happened to be, in those days they called it the Activities Director. My Dad decided one day that I needed to go back to school, and so he paid for my education, after 10 years.
Ellen Gardner: Is that when you went to Wichita?
Sherry Janzen: I was, yes.
Ellen Gardner: How do you come to go there?
Sherry Janzen: I had gone to school in Kansas at one of their universities to study music previously, and so still had friends in Kansas. But when I did my research of the gerontology programs around the US and Canada, Wichita State had the oldest gerontology program in the country at that time. We're talking like mid-'80s, and so it was not dealing just with money, it dealt with literally everything: the sociology of aging, psychology of aging, illness of aging. So it gave you a really good comprehensive picture of what it was like to work in the field of gerontology.
One of the things that I really questioned when I worked in my first job was there had to be a different way to provide care to residents in a nursing home. We would get them up at 6:00 in the morning. One morning I asked my boss, "Where are these people going? Why do we have to have breakfast at 7:30?" And it was all about the staff. It was not about the people who lived in the nursing home.
So, I always thought if I ever had the opportunity to run a nursing home, that it would not be like other nursing homes are.
Ellen Gardner: You seem like from that early age, Sherry, that you were already thinking in terms of asking the why questions. Why are we doing it this way? Maybe it can be done differently? Has that really been the defining characteristic of your leadership?
Sherry Janzen: Yes, because I think one of the things that the staff first really understood when I started my work at Salem Home, if I'd asked why things were done a certain way, and they would answer with, "Because we've always done it that way," that would not be the right answer. They learned really fast that was not the right answer to give me, because they had to tell me why they were doing it. Because if it wasn’t a legitimate reason, there was no reason not to say, "Let's try something else." But if it was just because it had been done that way, is there a different way to do it?
Ellen Gardner: Can you maybe give me an example, Sherry, of how that has played out? In other words, if they just say, "It's always been done that way. Why change it?", have there been things that have really changed in Salem Home as a result of that kind of philosophy?
Sherry Janzen: Well, I guess I can point to our model of care. About 10 years ago, when we had what we now refer to fondly as a mutiny by some of our leadership staff, it really made everybody stop and think about what we were doing, why we were doing what we were doing, and if what we were doing was what we should be doing.
And, out of that came a change in our mission and our vision, and our Model of Care. Residents get to sleep in. Their breakfast is a la carte when they get up. They have a bath day, they don't have a bath time. We have, over time, slowly changed how change is delivered, and the staff sometimes aren't quite sure that this is the right way to do it because they haven't ever done it this way before, but when you slowly just try and give it a chance, and they see that the residents are happier. They have less falls because you're not forcing them to do something. Our medication usage is down. Why wouldn't you want to do something that, just because you've done it, well, maybe it's time to take a 180 degree and look at it differently.
Ellen Gardner: So, can you tell me a little bit about how you came to adopt Relationship-Centered Care? Where did that come from? Is it a model that's unique to Salem Home?
Sherry Janzen: We call it Relationship-Centered Care because our whole lives are based on relationships. Good, bad, or ugly, but we have relationships in our lives. We asked ourselves, "Okay, so if we would ever live in a nursing home, what would we want to have happen?" Because the Baby Boomers are there and they are knocking on the door. We said, "Well, what's happening now is not what we would like," so that's how we started changing what we did, and then because of the relationship piece, that's why we started calling it Relationship-Centered because it's broader than just one person.
It's interesting because our staff have really adopted that philosophy. Their first job is to create or to establish a relationship with their resident, and then out of that comes a care plan. So you have to know your resident pretty well in order to be able to deliver the care plan.
Ellen Gardner: How does Salem Home support staff in education or training, and in ways does that will help them stay in the organization?
Sherry Janzen: Because we have so many residents with responsive behaviors, we have to give staff the ability to be able to interact with those residents, and to be able to manage them. That's a priority every year. We set aside out of our budget X number of dollars, these are the courses we have to send our staff through and you can tell. Like I actually had a colleague of mine walk into our building and they said, "We can tell that your staff are trained differently than other staff. They just know what to say and do."
Ellen Gardner: If I was to walk into Salem Home because I know Relationship-Centered Care or Person-Centered Care is the defining model of your home, what would I notice that's different if was an observer coming in?
Sherry Janzen: You'd probably see a lot of the staff talk, and that will include me, when you're walking down the hallway, we stop and talk to the residents. There's always interaction with the residents, and it doesn't matter what role you play in the organization. That's our first role, is to have a relationship. And so you'll see lots of staff interacting with residents. You'll experience lots of colour.
We've added DementiAbility: the Montessori Method™ for dementia into our organization, and most of the staff have gotten trained, but now we needed to have the environment for residents when they want to go someplace that in fact they do. So we now have a café and a laundromat, a flower shop, a salon, and a library. We were going to call it a bookshop but we thought we're going to confuse people. They're going to think they have to buy the books instead of just read them, so we said we'll just call it a library!
Ellen Gardner: That sounds great. It sounds very home-like – that you really can go from home to Salem Home and feel like you haven't made a huge transition, and I guess that's the point.
Sherry Janzen: And it's very busy. We have lots and lots of community groups come in to give programs. Lots of churches come in and give programs. Our Volunteer Coordinator just actually did some statistics, and in last year there were 403 entertainment groups that came through Salem Home.
Ellen Gardner: How high is the level of care provided? Does it range from residential care right through to full nursing care?
Sherry Janzen: We are mostly residential care. 97% of our residents have dementia of some form, and of those 75% have responsive behaviors. So we're always looking at finding different ways to provide residents with opportunities to engage in activities either with interactive walls or like the downtown I just talked about, so that there's something for them to do rather than just sit and be bored. That’s when you have responsive behaviors because they're trying to attract attention, they want to be noticed.
Ellen Gardner: How has Relationship-Centered Care evolved, because you've had it now for about 10 years?
Sherry Janzen: 10 years.
Ellen Gardner: How has Relationship-Centered Care evolved over that time?
Sherry Janzen: Well, we initially started with not making the residents' beds and making sure the resident was more important than the tasks. Over the years, we have introduced meal choice. We have the SuzyQ model of meal service which is like a little airline cart, and it wheels between the tables, and the residents can smell and see the food, and they can choose the food.
I think it's much more relaxed in our building than it used to be because there aren't always timeframes attached to everything. It used to be a meal was at this time, and bath needed to be at this time. Now there's still a schedule, but residents can choose if they want to participate or not.
Ellen Gardner: The SuzyQ Meal Plan, where did that come from?
Sherry Janzen: We went to decentralized dining in the mid-'90s because we were finding staff were walking too far, just to the central dining room. So we went to decentralized dining, so that it was the dietary staff who walked, not the care staff who walked, because the care staff are the ones that provide the care. Our cooks actually serve the meals, so that in fact they hear the complaints. It's not a nurse saying it to the cook, right? They're hearing it directly from the resident, and that was very intentional so that the cooks had interaction with the residents.
But then we needed to buy them time, so our Foundation bought two Rational Cooking Centers which means they can do multiple things at any given time and it cuts down timeframes on making meals. It's a little snowball, where you start one thing and then it's a snowball!
Ellen Gardner: Do the cooks like getting that kind of feedback?
Sherry Janzen: Oh, they love it. That's the best part of their day. When you see some of the residents and the cooks interact together, that's the best part of their day.
Ellen Gardner: That's beautiful, Sherry. Sherry, you've been CEO of Salem Home since 2004. Has your leadership style changed over the years?
Sherry Janzen: I think it's more relaxed than it used to be, but I have such a good staff I don't have to, I really don't have to do a lot. A lot of it comes from them. I think, for me, it's just a willingness to listen and to say, yes, or find the money. So in that way, yes, I think my leadership style has changed so rather than driving it, it’s being open and saying, "Just go do it."
Ellen Gardner: Can you tell me a little bit about your upbringing?
Sherry Janzen: Well, I thought about this question. I grew up on a dairy and a grain farm in Saskatchewan, and learned to work. There was just my sister and myself and then my parents, and I had really good parents in that they never said, "You're a girl, you can't do anything." So my sister and I never learned that there were limitations for us, which was really good when it comes to jobs like I have now. And my Dad was never one where he would say, "You go do this." He would always say, "Come, let's go, I'll show you how to do it" and then once we knew, then he would leave us alone.
Ellen Gardner: What has your Dad said about your choice of career now?
Sherry Janzen: He was always really proud. I think he was sad that I lived so far away from home, but I tried to get home as much as I could. It was interesting, though, when he went into care, and the struggles that we as a family. When you said, "Have I changed?" yes, I think I have changed in my style because there are certain things that happened when my Dad was in care that I will never tolerate in our building.
I saw the effect it had on my Dad, but also on us as his family, and how helpless you feel if nothing changes. And you try, and you ask, and you ask, and nothing changes. And I think the resident care managers have worked really hard to respond to families when things happen, or when somebody has a question, that they will answer and they will respond as fast as they can to build that trust, right? Because if you don't have trust with your families or your residents, you don't have much.
Ellen Gardner: Salem Home is owned by 13 Mennonite Churches, and the churches and the community play a big role in providing programs for residents.
Sherry Janzen: Yes.
Ellen Gardner: How does that play out in practice?
Sherry Janzen: We have 216 volunteers who are active volunteers in our building. They come at all hours of the day. They help porter, they help residents with their meals. They do some service things. And then the churches bring programs. They bring services on Sunday morning, chapel during the week, and then a lot of the churches and service groups in Winkler or surrounding area will also bring programs.
It's like a little community within the community, and it's really neat to see. You you don't get bored at Salem very often!
Ellen Gardner: I wanted to ask when you interview prospective candidates to work at Salem Home, what do you look for?
Sherry Janzen: For me personally when I hired my own personal, I say my own personal staff, they aren't my personal staff, trust me. They're directors in the organization. They would have to be people persons. You can learn process. You can learn all those things, but you can't change your personality. We've had a number of people in our organization who weren't people persons, and there were lots of bridges to build after they left. So that would be something that will be very critical to me.
My test is we have a group of about 17 of us who get together almost every other week. It's our leadership group. It's the directors, the managers, and then all of our supports like my assistants and Marilyn's assistants, and all the assistants, because if they don't understand what we're trying to build, they can't help us, right? So we all sit the table together. My test in my head is, if that person would fit that group because that group has evolved into this organism inside the building that literally, when you talk about passion in the building, that's that group.
We have one that started as a dietary aide and is now the Director of Support Services, so we try to mentor inside because I think it's, not that you can't do it, but I think it's harder for someone coming in brand new into our model of care, and really get why we do. It would take a long time for them to really understand how deep that goes inside the organization. We don't just say it. We live it.
Ellen Gardner: Through any career, Sherry, there are lots of ups and downs, and you go through experiences and all that makes you a wiser person. So what kind of career and life advice do you give to new graduates?
Sherry Janzen: I think the most important thing you can do when you walk into a new job, a new organization, is to listen and to, we just learned this the other day, to ‘read the air’. You know, there's so much that goes on that's unspoken, and just to be aware that there might be some things happening underneath that you don't know, right? I think that they need to understand that what they learned in school is probably not what they're going to encounter in the real workplace, generally speaking, and they need to be prepared for that.
You know, I remember when I got my new grad dietitian, and she was so bent on all the food groups on every meal, and the residents just wanted potatoes. I said, "No." She says, "But I have to have these good groups." I said, "No. They want potatoes." I said, "This is the real world," and somehow you have to marry your theory with what happens in the real world, and be okay with it.
Ellen Gardner: That's very true. Sherry, I really want to thank you for sharing your thoughts and your philosophy, and all the amazing things that happen at Salem Home. I just want to thank you so much.
herry Janzen: Thank you, Ellen, for having me.